The price of health insurance keeps millions of Americans from getting it, but many people don't know how much health insurance actually costs. And many are not used to building that cost into their monthly budget. NPR's Richard Knox reports that this is emerging as a key issue in the debate over whether all Americans should be covered.

RICHARD KNOX: Ann Notzelman of Flemington, New Jersey, says she can only afford about $100 a month for health insurance. She's only making about $20,000 a year.

Ms. ANN NOTZELMAN: Right now I'm in between jobs. And that's mainly why I can't afford to dish out the money that they'd want, you know? Because the cheapest plan I think I've seen was somewhere - like in the 300 range.

KNOX: Notzelman worries about her lack of coverage every day.

Ms. NOTZELMAN: Actually, I'm a little concerned with a lump that I have. I know, it's not good — because my mother had breast cancer — so that's why I'm a little concerned, you know?

KNOX: Notzelman represents a big part of the uninsured problem Washington policymakers are grappling with. There's little doubt low-income people like her would need substantial government help with the premium.

But a more difficult issue is whether middle-class Americans will need subsidies to buy coverage if their employer doesn't pay a chunk of the premium.

Massachusetts has experience with that problem. It's the first state to require nearly everybody to have health insurance, and it helps out the poor. Drew Altman is president of the Kaiser Family Foundation.

Mr. DREW ALTMAN (Kaiser Family Foundation): Literally, we didn't know whether people in Massachusetts would say, hell no, I won't go; I'm going to New Hampshire or Rhode Island - or they would participate in the program.

KNOX: So far, it seems to be working. If you make up to $33,000 a year, Massachusetts subsidizes your coverage. People who make more than that have to pay the whole premium. Only about 15 percent of the uninsured have asked to be exempted.

But a new poll finds that some uninsured Americans who make good money say they can't afford health insurance on their own. The poll was conducted by NPR, the Kaiser Foundation, and the Harvard School of Public Health. Two out of every three uninsured Americans say they'd be willing to pay no more than $100 a month for coverage. James Brancatelli told our pollsters he'd be willing to pay more, but only $200 a month, tops.

Mr. JAMES BRANCATELLI: I haven't had insurance for the past four years.

KNOX: Brancatelli delivers pharmaceuticals. We caught him on his rounds in Tucson, Arizona. He's self-employed.

Mr. BRANCATELLI: So unfortunately, if I want health care, I have to purchase it myself. And unfortunately, for me and my wife, it is about $400 a month.

KNOX: He and his wife have put off having a baby because of the cost.

Mr. BRANCATELLI: We've looked into that. And to have a child, it'll roughly cost us about $30,000 without having insurance. So it's crazy.

KNOX: Massachusetts has tried to come up with affordable plans for people with middle-class incomes. I entered Brancatelli's information into a government Web site to see what he could buy if he lived there.

I'm going to put my ZIP code in.

Mr. BRANCATELLI: Okay. That will be fine.

KNOX: I live in Boston. You were born in what year?

Mr. BRANCATELLI: I was born in 1965.

KNOX: Okay. Pressing the button. Okay, so there are 19 plans in the Boston area for you. And the low-cost one, you could get for $615 a month. So if you lived in Boston, would you be buying the $615 a month plan?

Mr. BRANCATELLI: Still would probably be out of my price range.

KNOX: The Brancatellis make $80,000 a year. Their bills total 3,500 a month. After gas, food and other expenses, he says, there's not much left over.

If the Brancatellis lived in Massachusetts, they'd be expected to pay 10 percent of their income for health insurance. That's about $670 a month. So far, most people in Massachusetts have gone along with that.

Mr. BRANCATELLI: If there was a subsidy for that, you know, we would have no problem with that, you know. But since we don't have that, we just can't afford to put out $8,000 to $10,000 a year for health coverage.

Economist Jonathan Gruber of MIT says if everybody's going to be covered, some people will have to get used to the idea of paying more than they think they can.

Professor JONATHAN GRUBER (MIT): To my mind, the biggest gain for national health insurance is not necessarily in terms of improving health. There's just a huge benefit in not having to go to bed at night worried about whether you're going to wake up with cancer and therefore, go bankrupt. You know, the insurance is not just about getting to see the doctor. It's about protecting yourself against financial catastrophe, and that's worth something.

KNOX: He says the nation needs to create a culture of health insurance, where people think it's as much a part of a budget as car payments and utility bills.

Richard Knox, NPR News, Boston.

MONTAGNE: And you can get more key findings from that health-care poll at npr.org.

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